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South Dakota rates for HCPCS A5093

Ostomy accessory; convex insert

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.62 / $3.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $3.02 / $12.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.55 / $35.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $3.02 / $3.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $4.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.75 / $3.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.35 / $2.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45